Audiology & Hearing

Even mild hearing loss can affect a child’s ability to speak and understand language, as well as impact behavioral development. Nemours' audiologists use state-of-the-art technology and innovative testing techniques to assess your child’s hearing sensitivity. We can evaluate and treat hearing at any age, beginning at birth.

Read More About Audiology

Hearing loss in children occurs in an estimated three out of every 1,000 babies born in the United States each year. At Nemours, we are dedicated to finding the best solutions to address each child’s hearing impairment, and we’re committed to counseling and educating families to be advocates for their children in the community.

We have board certified audiologists who are licensed with specialized experience in pediatric audiology.

Our audiologists help diagnose and develop treatment plans for children with hearing disorders such as:

hearing loss

(central) auditory processing disorder (APD)

auditory neuropathy spectrum disorder (ANSD)

balance (vestibular) and dizziness disorders

At Nemours/Alfred I. duPont Hospital for Children and a number of Nemours Children’s Clinic locations in the Delaware Valley and North and Central Florida, we are also able to provide children with hearing impairment special services.

These services include:

prescriptions for hearing aids and other assistive and/or amplification devices as well as instruction on the use, care and maintenance of these devices

Call for an appointment to find out about scheduled days and available testing. (Hearing aid fittings are done downtown at Nemours Children Clinic, Jacksonville.)

Working Together to Meet Your Child’s Hearing Needs

Early identification and management of hearing loss and auditory disorders is crucial to minimizing delays in speech, language and cognitive development. At Nemours, we use the most up-to-date equipment and innovative pediatric assessment techniques to determine your child’s hearing sensitivity and management needs.

We also take a multi-disciplinary approach for our many of our services, collaborating with our Nemours ENT (Ear, Nose and Throat) specialists and others, to gather the information and details needed to assist your child most effectively.

Our services include assessment, management and monitoring of children with conditions such as:

Central Auditory Processing Disorder

We are North Florida’s referral center for children with central) auditory processing disorder (CAPD). Children with CAPD have no problem hearing, but they do have difficulty interpreting and storing words that are heard because the ears and brain do not fully coordinate.

Vestibular (Balance) Disorders

Our Pediatric Vestibular team offers advanced testing and treatment for balance problems (dizziness, falling or the sensation of falling, headaches, disorientation, or nausea) caused by problems of the inner ear. Our state-of-the-art and pediatric-friendly equipment helps pinpoint the cause of the problem, to provide appropriate treatments and recommendations.

Auditory Neuropathy Spectrum Disorder

We have a specialized program for children with auditory neuropathy spectrum disorder (ANSD), an auditory nerve disorder that can make it difficult for children to hear or distinguish one sound from another. Our program targets diagnosis, treatment, and research.

Hearing Loss

About 3 in 1,000 babies are born with hearing loss (also called hearing impairment), making it the most common birth defect. A hearing problem can also develop later in life. Our program is designed to closely monitor hearing loss in children. We collaborate with the ENT (Ear, Nose and Throat) department to investigate the possible cause of your child’s hearing loss. Along with a thorough ENT and Audiology consultation, evaluations by other specialties, including genetics, imaging, and vestibular (balance), may be recommended, depending on your child’s needs.

Hearing Evaluations

Our Audiologists conduct full hearing diagnostic evaluations in sound-treated rooms with specialized, state-of-the-art equipment. The methods used to test a child’s hearing will depend on the age of the child, the child’s ability to cooperate, developmental, and health status.

General Hearing Tests and Evaluations

Typically, hearing evaluations begin with general diagnostics, or behavioral testing, in one of our sound-proof booths. These tests include:

Behavioral Audiometry

Hearing tests based on child’s age and functional level:

Children 6 months to 3 years: Visual Reinforcement Audiometry (VRA). The child is seated on the parent’s lap and sound is transmitted through the soundfield speakers, looking for localizations or changes in behavior. This is not an ear-specific test, but reflects the sensitivity of the better ear.

Children 3-5 years: Conditioned Play Audiometry (CPA). The child wears either insert earphones or supraaural (headphones) and responds to ear-specific stimuli through the use of a game (i.e. putting a coin in the bank etc.).

Children 5-18 years: Standard Behavioral Testing. The child wears insert or supraaural earphones and responds to stimuli by repeating a word or pressing a button.

Tympanometry & Middle Ear Muscle Reflex (MEMR) Testing

Tests eardrum flexibility and reflexes of the middle ear muscle. While not a hearing test, it is helpful in identifying middle ear problems, such as fluid collecting behind the eardrum.

The child’s ears are evaluated with an immittance bridge by placing a soft tip in the ear which then assesses eardrum movement, middle ear pressure, and the reflex of the middle ear muscle. This does not require a response from the child, although sitting quietly is required for this brief evaluation.

Otoacoustic Emissions (OAEs)

Measures the function of the outer hair cells, or the “natural amplifiers,” which lie inside the cochlea.

During an OAE test, a soft tip is placed in the child’s ear canal, which transmits sound to measure the outer hair cell function in the cochlea. This can be obtained in seconds on a sleeping infant or an older child who is able to sit quietly.

A normal recording is associated with normal outer hair cell function and this typically reflects normal hearing although in some cases the hearing loss may be due to problems in other parts of the hearing pathway.

Specialized Testing

If your child need further testing beyond the behavior hearing evaluation, your audiologist may recommend one of the following diagnostic tests.

Auditory Brainstem Response (ABR)

This diagnostic test evaluates functioning of the auditory (hearing) nerve, and can be used as a predictor of hearing level. It is done while the baby/child is asleep (if 3 months or under) or sedated (over 3 months of age).

ABR testing is commonly performed on:

babies that have failed their newborn hearing screening two times and have been medically cleared of middle ear fluid.

children who are uncooperative for behavioral testing.

children who cannot be reliably tested using general diagnostic tests (e.g., due to developmental delay, syndrome-related, etc.).

Testing is performed by placing soft electrodes on the baby/child and an insert tip in the ear canal, which sends a click sound to the ear.

Audiologists then measure the neural response and determine the child’s threshold of hearing. It lasts approximately 1-2 hours.

Central Auditory Processing (CAP) Evaluation

This type of testing help diagnose Auditory Processing Disorder, where the child has difficulty processing what is heard because the ears and brain do not fully coordinate.

CAP testing is for children age 7 and older, to evaluate what happens to an auditory signal once it leaves the peripheral system (cochlea) and travels to the brain.

It is conducted in the test booth and requires the child to listen and respond to various exercises. It is for children with normal intelligence and normal hearing who exhibit difficulties processing information (e.g., trouble hearing in noise, difficulty following multi-step directions, poor reading/spelling/language skills, oral comprehension problems, etc.). This evaluation takes approximately 3 hours.

Auditory Neuropathy Spectrum Disorder (ANSD) Evaluation

This testing assesses the function of the auditory (hearing) nerve. Abnormal nerve function can make it difficult for children to distinguish one sound from another and understand speech clearly.

This testing is conducted the same way an ABR is done but looks at a different part of the response. The disorder occurs when sound enters the inner ear normally, but the transmission of signals from the inner ear to the brain is impaired —which is typically exhibited by present OAEs (Otoacoustic Emissions from the outer hair cells, or the “natural amplifiers,” which lie inside the cochlea) and absent or impaired ABR (Auditory Brainstem Response). We routinely do this evaluation as part of a diagnostic ABR and CAP (if warranted) to rule it out, but the test can be done independently without proceeding to do a threshold search.

It lasts about 1 hour and would be recommended for children when:

parents report their child to have difficulty understanding speech clearly, especially in the presence of background noise

speech and language development is a concern- children with this disorder can have speech and ranges from mildly distorted to absent

Balance (Vestibular) Disorder Evaluation

Our balance system is made up from 3 areas in our bodies: the inner ear, the eyes, and our proprioception (use of muscles and joints to maintain body position). Nemours audiologists are part of a comprehensive, multi-disciplinary team that can assess symptoms of balance problems (dizziness, falling or the sensation of falling, disorientation, or nausea), help identify their cause, and develop a successful course of treatment.

Vestibular testing includes:

Audiometry: hearing test

Tympanometry and MEMR: Tests eardrum flexibility and reflexes of the middle ear muscle

Otoacoustic Emissions (OAE): Measures the function of the outer hair cells, or the “natural amplifiers,” which lie inside the cochlea

Videonystagmography (VNG): Records and measures eye movement to check for the presence of vestibular system abnormalities

Rotational Chair Testing (RVT): Tests the function of the vestibuloocular reflex (VOR), which allows us to keep objects in focus as we walk, play, and run

Vestibular Evoked Myogenic Potential (VEMP): Assesses a specific part of the inner ear and vestibular nerve for abnormalities

Rehabilitation and Treatment

If your child is diagnosed with hearing loss or other hearing impairment, our audiologists will make appropriate recommendations based on your child’s specific needs and impairment.

Hearing Aids: If hearing aids are necessary, Nemours audiologists are qualified and experienced in the evaluation, fitting and management of hearing aids for children of all ages, including babies as young as three months. As part of our program, we closely monitor your child’s hearing loss and hearing aid care.

Frequency Modulated (FM) Systems: For some children with hearing loss or hearing impairment, background noises and distance can interfere with hearing and understanding. FM amplification systems can be used by children with hearing aids, as well as those children who are not candidates for hearing aids.

Implantable (surgically-placed) Bone Conduction Hearing Devices

We offer two implantable hearing devices for children, age 5 years and older, with conductive or mixed hearing loss. These devices can also benefit children with single sided deafness — and both devices can be worn in a softband prior to age 5 years or if implantation is not desired.

BAHA (Bone Anchored Hearing Aid): The BAHA is a surgically implanted system that works through direct bone conduction. The system works by enhancing natural bone transmission as a pathway for sound to travel directly to the inner ear, bypassing the outer and middle ear. The implant is placed during a short surgical procedure, which over time integrates with the skull bone — usually 3-6 months, depending on the age of the child. Once integrated, the processor is worn on the external abutment and transmits sound vibrations via the abutment to the implant. The implant vibrates, sending vibrations within the skull and inner ear. Hair cells within the inner ear stimulate nerve fibers, allowing hearing to occur.

Sophono Bone Conduction Hearing System: The Sophono is an innovative, new abutment-free device. This system eliminates the need for a protruding abutment by utilizing a magnetic titanium implant, which securely holds the external processor in place through intact skin and hair via an external spacer magnet. The Sophono is implanted in a short, single stage procedure. The processor can be fitted for the patient in about 4 weeks after surgery or once the incision has healed. Like the BAHA, direct stimulation to the cochlea via vibrations allows for hearing to occur.

Cochlear Implant: A cochlear implant is a surgically implanted device for individuals with severe to profound hearing impairment who receive little to no benefit from hearing aids. The procedure does not restore hearing. What it does is transmit sound information past the damaged cochlea directly to the nerve of hearing. We provide a comprehensive Cochlear Implant and Auditory Rehabilitation Program, giving long-time support to children and families with ongoing therapy and involvement before and after surgery.

Auditory-based Therapy

Our speech and language pathologists work one-on-one with children to teach or re-teach speech and hearing skills. We can provide these services to children regardless of their primary language at home. Our speech and language services for children with cochlear implants involve a technique called auditory-based therapy. Our program is delivered by therapists and follows a set of guiding principles that include an emphasis on early and consistent amplification, intense family participation, and therapy that focuses on developing speech through natural development patterns.

The methods used during therapy sessions are taught to parents, who will continue the training at home in their child's natural environment. The goal is to maximize the use of your child’s residual hearing in order to develop expressive speech that is melodic and natural. The program emphasizes the meaning and pragmatics of language, rather than articulation – which means language is shaped, or “caught,” rather than taught. The results are children who have natural-sounding speech and language, are excellent communicators, and are at a cognitive level similar or equal with their hearing peers.

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